Case ReportOpen Access

Key points in Diabetes Insipidus´ Diagnosis

Volume 2 - Issue 1

Mara Capra*¹, Ana Raisa Jatahy Santos¹, Sabrina Pinto Ferreira¹, Moacir Benazzi¹, Larissa Bianca Paiva Cunha de Sá¹, Helen Paula Apparicio Medeiros¹, Mirella Hansen de Almeida^1,2 and Alberto Krayyem Arbex^1,3,4

Author Information Open or Close
- ¹Endocrinology Division, IPEMED Medical School, Rio de Janeiro, Brazil
- ²Division of Endocrinology, Central Air Force Hospital, Rio de Janeiro, Brazil
- ³Diabetology Department, Malteser Franziskus Krankenhaus Flensburg, Germany
- ⁴Former Visiting Scholar, Harvard TH Chan School of Public Health, Boston, USA
*Corresponding author: Rua dos Jasmins, 326. Jardim Laguna, Linhares – Espírito Santo, Brazil

Received: January 17, 2018; Published: January 23, 2018

DOI: 10.26717/BJSTR.2018.02.000684

Full Text PDF

To view the Full Article Peer-reviewed Article PDF

Abstract

Diabetes insipidus is mainly characterized by polyuria, urinary volume over 3 L/day or 40mL/kg/day in adults, leading to subsequent polydipsia; these features are also present in most cases of diabetes mellitus. We report the case of a 56-year-old man initially misdiagnosed with and treated for diabetes mellitus; he was eventually diagnosed with central diabetes insipidus following further laboratory tests. We have also conducted a thorough review of the literature relating to the physiology, diagnosis, and treatment of diabetes insipidus. The patient, who complained of polyuria, polydipsia and weight loss, and had fasting glucose levels of 108 mg/dL, was already using metformin to treat type 2 diabetes. He then developed hypoglycemic symptoms, and pre- and postprandial capillary glycaemia between 70 and 120 mg/dL, as a result of which metformin was suspended. Nevertheless, polyuria and polydipsia persisted. Based on a plasma osmolality of 305,5 mOsm/kg, urinary density of 1005 g/mL and low arginine vasopressin levels, a diagnosis of central diabetes insipidus was made and treatment with desmopressin was initiated. Because the symptoms of centraldiabetes insipidus and uncontrolled type 2 diabetes mellitus overlap, it is important to consider clinical presentations carefully in order to make a differential diagnosis.

Keywords: Central Diabetes Insipidus; Osmolality; Desmopressin; Polyuria; Polydipsia

Abbreviations: DI: Diabetes insipidus; AVP : A Vasopressin; DM: Diabetes Mellitus; CDI: Central Diabetes Insipidus; PP: Primary Polydipsia